Management of infected lesser sac walled-off pancreatic necrosis (WOPN) is technically challenging and involves endoscopic ultrasound (EUS)-guided transmural drainage using either lumen-apposing metal stent (LAMS) or multiple plastic stents as the standard approach. A step-up approach—drainage followed by additional direct endoscopic necrosectomy (DEN) whenever required—has been a standard recommendation. Collections extending to the paracolic gutter are difficult to manage endoscopically and often require additional surgical intervention. In this video case, we describe a combined approach using EUS-guided LAMS and percutaneous fully covered self-expandable metal stent-guided DEN (e-DEN + p-DEN) for successful management of an infected lesser sac WOPN with paracolic extension.
Keywords
walled-off pancreatic necrosis - WON - WOPN - percutaneous direct endoscopic necrosectomy - direct endoscopic necrosectomy - DEN - DEN - p-DEN
